Thursday, November 17, 2011


Vultures in a field ploughed 6 weeks ago, now sprouting green shoots
Theres a movie that I haven’t seen called Ground Hog Day, but I believe its about someone reliving the same day over and over again – an eastern concept I suppose, the cycle of birth and rebirth turning over and over until somehow or other, one escapes into a better place. But work here is very much Ground Hog Day, pretty much the same thing day after day, always challenging and too often dramatic and tragic but that same mix of poverty, chaos, frustration, blood , dirt and death.

Yesterday was a perfect example: we have only six midwives here – one took leave last week, but was not missed as his contribution was never more than minimal. Another took annual leave for two weeks starting two days ago, and yesterday three more left to go to a 3 day course on contraception, leaving one midwife and myself plus, luckily, a new volunteer midwife who arrived from Holland 5 days ago.  But this sort of mismanagement of staff is common – slightly less annoying was when they were all at a conference at the Wubet Hotel every day for a week – at least when we needed someone we could call them back!

During the morning,  the hand held device for checking a babies heart beat stopped working because the battery was flat. Fortunately the midwife who controls access to the Store room had left the key to it with me – I insisted as previously the key went with the midwife and we couldn’t get needed supplies – grrrrr- so I went to get  another battery – but there were none ( of course ) Eventually, it was decided that someone coming back from Bahar Dar  today would bring one (!) – I insisted they should bring at least four! It will be interesting to see what turns up – the wrong size perhaps?

Meanwhile a woman gave birth to a very small baby from an abdomen that looked like it should have had a much bigger baby in it – and fortunately Myrte the astute Dutch Midwife realized the other possibility was an undiagnosed Twin pregnancy – and so it proved to be, our sole remaining working local midwife confidently delivering the second one as a breech, as I watched. But of course, sadly these two little boys were  doomed, far too premature to survive anywhere in Ethiopia except perhaps in the big hospital in Addis, though at 1.2 and 1.5kg, in Holland or Australia, given their vigorous health at birth, they would very likely have survived and developed normally -not always of course, even in the “West” bad outcomes will still result despite every effort – and there will be up to date figures on the likely survival of twins of that size published somewhere – but my guess is at least 75% will go home eventually in near perfect health. Instead, we warmly wrapped the two little boys together and they were embraced by their mother who lay there with them until in a couple of hours, they quietly “expired”, a single tear in their mothers eye. And then her poor family took her home.
The One Birr Note ( = 6 cents )
Later, at about 9pm, I gave up squeezing fresh air into the lungs of another baby we had just delivered, hoping it would start to breath but the only sign of life was his beating heart. His problem was the opposite of the twins, he was born after a long labour well past his due date by the look of his skin and all the meconium he was covered in at birth. The student midwives  looking after him had said the  babies heartbeat was “fine” in labour, which really just means “present”. We don’t have the sophisticated machines we use in the west which record the exact rate and the pattern of its responses to contractions,  information which can alert us to the possibility of the babies distress. But when I checked it myself it was very fast, an indicator of probable distress and so we accelerated its birth with a Kiwi  Cup– but it was too late. Even so, the husband and grandmother tearfully embraced me and hugged my legs when after 20 minutes I decided to stop trying to keep the baby alive. He had a very sweet face that baby….

A typical Motta house
In amongst all those dramas, and with the mostly useless  student mdiwives getting in the way all the time we had a couple of women arrive bleeding with miscarriage, other women needing scans, we diagnosed a urinary fistula in a woman who had given birth to a dead baby at home about a month ago, and we brilliantly managed the labour and delivery of a healthy boy to a woman having her first. She was a sister of one of the midwives on leave so everyone was very concerned and there was an enormous throng of family and friends and other hospital staff in attendance, and at the beginning of the labour things looked challenging as the baby was in an unfavorable position, not nicely settled into the pelvis.Even I, forever the optimist about womans ability to give birth naturally, had warned that she may need a caesarean. In this situation, with all that family and colleague pressure, its easy to think of a reason to do one, but there are only two bona fide reasons for a Caesarean in labour – obstruction, and fetal distress, neither of which were present. The tendency in the west is to delude yourself, and think that you can predict the future, and advise gravely,  that if labour continues, one or other of these conditions will develop, so the caesarean may as well be done now ( rather than later, and interrupting golf perhaps? ) This dilemma is sometimes rather duplicitously – if that’s a word - presented as a “choice” between a caearean now and contunuing - which is the strictly correct thing to do -with a subtle message that the baby might be harmed if not delivered  immediately – and which frightened confused and anxious mother is ever going to turn down the wise counsel of her trusted obstetrician? Hence a caesarean rate of around 30%.  And millionaire obstetricians.  The obscenity of it all seems stark from this place.

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